Extended Literature Review of the role of erythropoietin stimulating agents (ESA) use in the management of post renal transplant anaemia

Q4 Medicine

Transplantation Reports Pub Date : 2022-06-01 DOI:10.1016/j.tpr.2022.100097

Iman Alshamsi

{"title":"Extended Literature Review of the role of erythropoietin stimulating agents (ESA) use in the management of post renal transplant anaemia","authors":"Iman Alshamsi","doi":"10.1016/j.tpr.2022.100097","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>: Anemia is known to impact quality of life and survival in both renal and non-renal patients. End stage kidney disease (ESKD) patient's survival substantially improves post transplantation. Observational studies have reported better patients and graft outcomes in non anemic renal transplant recipients. Anemia of chronic kidney disease (CKD) is frequently linked to erythropoietin deficiency. Patients with post-transplant anemia (PTA) represent a distinct subset of CKD population. The benefit of using erythropoietin stimulating agents (ESA) in PTA is not clearly defined.</p></div><div><h3>Aim</h3><p>: The aim of this extended literature review is to define the role of ESA use in improving hemoglobin (Hb) level and graft survival in patients with PTA.</p></div><div><h3>Methods</h3><p>: An extended literature review was done to identify randomized controlled trials (RCTs) with patients with PTA as the study population, the use of erythropoietin stimulating agents as the intervention, and the renal function and Hb level as the outcomes. The aim of this literature review is to delineate the role of using ESA in PTA. Medline, Google scholar, Scopus, and CINHAL data bases were searched and papers meeting the pre-set inclusion criteria were identified.</p></div><div><h3>Results</h3><p>: A total of 163 papers were identified. After screening the results, four papers met the inclusion criteria and were included for review. 2/4 papers recruited patients with early PTA, while 2/4 papers recruited patients with late PTA. The early PTA papers were not consistent in reporting the effect of ESA in improving renal outcomes. Both studies showed that using ESA had no additional benefit in anemia treatment. 2/4 studies looked at late PTA. The study designs were similar and the follow up period was 2-3 years. Both studies showed a better graft survival in the higher Hb group.</p></div><div><h3>Conclusion</h3><p>: In the case of early PTA, the benefit of using ESA is not clear. The two RCTs studying the effect of ESA in patients with late PTA showed that targeting higher Hb levels was associated with better graft function. The optimal Hb target and the utility of intravenous iron need further clarifications.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"7 2","pages":"Article 100097"},"PeriodicalIF":0.0000,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959622000063/pdfft?md5=7a437426d3dfbe5bb03cc1e2a6d0aa84&pid=1-s2.0-S2451959622000063-main.pdf","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2451959622000063","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 1

Abstract

Background

: Anemia is known to impact quality of life and survival in both renal and non-renal patients. End stage kidney disease (ESKD) patient's survival substantially improves post transplantation. Observational studies have reported better patients and graft outcomes in non anemic renal transplant recipients. Anemia of chronic kidney disease (CKD) is frequently linked to erythropoietin deficiency. Patients with post-transplant anemia (PTA) represent a distinct subset of CKD population. The benefit of using erythropoietin stimulating agents (ESA) in PTA is not clearly defined.

Aim

: The aim of this extended literature review is to define the role of ESA use in improving hemoglobin (Hb) level and graft survival in patients with PTA.

Methods

: An extended literature review was done to identify randomized controlled trials (RCTs) with patients with PTA as the study population, the use of erythropoietin stimulating agents as the intervention, and the renal function and Hb level as the outcomes. The aim of this literature review is to delineate the role of using ESA in PTA. Medline, Google scholar, Scopus, and CINHAL data bases were searched and papers meeting the pre-set inclusion criteria were identified.

Results

: A total of 163 papers were identified. After screening the results, four papers met the inclusion criteria and were included for review. 2/4 papers recruited patients with early PTA, while 2/4 papers recruited patients with late PTA. The early PTA papers were not consistent in reporting the effect of ESA in improving renal outcomes. Both studies showed that using ESA had no additional benefit in anemia treatment. 2/4 studies looked at late PTA. The study designs were similar and the follow up period was 2-3 years. Both studies showed a better graft survival in the higher Hb group.

Conclusion

: In the case of early PTA, the benefit of using ESA is not clear. The two RCTs studying the effect of ESA in patients with late PTA showed that targeting higher Hb levels was associated with better graft function. The optimal Hb target and the utility of intravenous iron need further clarifications.

查看原文本刊更多论文

对促红细胞生成素刺激剂(ESA)在肾移植后贫血治疗中的作用的扩展文献综述

背景:已知贫血会影响肾脏和非肾脏患者的生活质量和生存。终末期肾脏疾病(ESKD)患者移植后生存率显著提高。观察性研究报告了非贫血性肾移植受者的患者和移植物预后较好。慢性肾脏疾病(CKD)贫血通常与促红细胞生成素缺乏有关。移植后贫血(PTA)患者是CKD人群中一个独特的子集。在PTA中使用促红细胞生成素(ESA)的益处尚未明确定义。目的:这篇扩展文献综述的目的是确定ESA在改善PTA患者血红蛋白(Hb)水平和移植物生存中的作用。方法:对以PTA患者为研究人群，以促红细胞生成素刺激药物为干预手段，以肾功能和Hb水平为结局的随机对照试验(rct)进行文献综述。这篇文献综述的目的是描述使用ESA在PTA中的作用。检索Medline、Google scholar、Scopus和CINHAL数据库，确定符合预设纳入标准的论文。结果:共筛选出163篇论文。经筛选结果，有4篇论文符合纳入标准，纳入综述。2/4的文献招募了早期PTA患者，2/4的文献招募了晚期PTA患者。早期的PTA论文在报道ESA对改善肾脏预后的影响方面并不一致。两项研究都表明，使用ESA在贫血治疗中没有额外的益处。2/4的研究着眼于晚期PTA。研究设计相似，随访2-3年。两项研究均显示高血红蛋白组的移植物存活率更高。结论:在早期PTA病例中，应用ESA的益处尚不明确。两项研究ESA对晚期PTA患者影响的随机对照试验显示，靶向较高的Hb水平与更好的移植物功能相关。最佳的血红蛋白靶点和静脉铁的效用需要进一步澄清。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Transplantation Reports Medicine-Transplantation

CiteScore

0.60

自引率

0.00%

发文量

审稿时长

101 days

期刊介绍： To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI